Case reports are a useful method of identifying unique case presentations, often with important clinical caveats. Unfortunately, with the pressure on space, especially in high impact journals such as Thorax, the ability to accept case reports for publication is extremely low. A number of years ago Thorax, recognising its inability to publish more than a minority of case reports submitted, introduced what has transpired to be the very successful “Images in Thorax” section. Despite this, the pressure to publish case reports continues, unabated.

Recognising that there will continue to be a need for innovative case reports, especially those that speculate on innovative new hypotheses, we feel that there is a role for a more educational format for case reports. Therefore, unless a case report has unique content and, in particular, provides data not previously reported, it should be changed into a “Pulmonary puzzles”. These puzzles will consist of a brief clinical summary and appropriate image, from which the reader will be asked to provide a possible diagnosis. The reader will then be referred to another page later in the same issue of Thorax where the key diagnostic test(s) will be provided along with a brief overview of the condition in question. Preference will be given to reports that provide important learning points, especially for trainees. The text should be no more than 500 and no more than two images of either a radiological or pathological nature should be submitted. The references will be limited to a total of five, and in general will refer to a comprehensive review of the diagnostic and or therapeutic aspects of the case report in question. In addition to publication in Thorax, these Pulmonary puzzles will be posted on the Thorax website and will provide an important educational resource for both respiratory physicians in training, as well as practicing consultant respiratory physicians.

We anticipate that this new addition to Thorax will provide an important educational resource for readers of the journal.